Reviving Tigray’s Health System to Prevent Maternal Deaths

First published January 10, 2024 by UNFPA.

For the first time after the conflict in Tigray, a healthy baby boy was delivered by C-Section at Adi Daero Primary Hospital.

On November 22nd, 2023, for the first time in over a year after the conflict, surgeons at Adi Daero Primary Hospital started to bring life into the world again. Forty-year-old Wahid Hadush became the first mother to deliver a healthy baby via Cesarean section.

Wahid had traveled from Adi-Abagi with an ambulance. Upon her arrival, doctors realized that her child had a non-reassuring fetal heartbeat pattern, meaning the child’s heart rate was abnormal. The doctors immediately admitted her into the OR, to conduct an emergency C-Section, and were able to save the child – something that would have been impossible just weeks earlier.

For nearly three years, Adi Daero Primary Hospital, located 30 kilometers from Shire Endassilasie, had been operating at minimum capacity as the facility struggled to recover from a devastating two-year conflict. The once-bustling primary hospital, serving a catchment area of over 130,000 people, stood as a grim testament to the conflict’s devastation.

Adi Daero Primary Hospital

With a team of 11 doctors and 11 midwives, as well as 6 ambulances, it was the area’s sole primary hospital with catchment health centers and other small health posts depending on its referral capacity. But in November 2022, amid conflict, the hospital was burned to the ground, making it just one of the many health facilities devastated by the conflict.

Health Resources and Services Availability Monitoring System (HeRAMS), published in October 2023 by the World Health Organization, showed that of the accessible health facilities in the Tigray region more than 90 percent were partially or completely damaged with 98 percent lacking essential family planning supplies, and 93 percent of referral facilities lacking the basic supplies necessary for providing key obstetrics services or signal functions for pregnant women and newborns.

“We tried to provide emergency care,” recounted Yemane Tesfa, the hospital’s Chief Executive Officer. “We had no equipment, barely any staff, but we used the open ground and unfinished structures to offer whatever services we could.”

Tigray, in the north of Ethiopia.

In March 2023, UNFPA (the United Nations Population Fund), along with its partner, Medical Teams International (MTI) stepped in. Two of the unfinished wards at the hospital were refurbished and provided with vital medical equipment. This allowed for the revival of first the maternity wards and soon after the OR services. Deliveries, once just 10 per month, have now surged to 70. Major and minor surgeries have resumed, offering a critical lifeline to the community. The referral system has been revitalized, with ambulances fueled by UNFPA’s partner ensuring timely transfers for critical cases.

This was made possible with the support of Canada, which has been a vital partner in supporting Sexual and Reproductive Health care for women and girls all over Ethiopia. The Government of Canada is providing USD 15.9 million to enable UNFPA to scale up essential health services across conflict-affected regions. Assisting in reviving health systems devastated by conflict; including in the provision of contraception, skilled health workers, and essential reproductive health medicines.

However, the hospital has yet to resume normal operations. Much more would need to be done to revive the hospital’s infrastructure. Of the six ambulances the hospital used to have, there is only one remaining. It is also struggling to regain its human resources, now operating with just four doctors, “the health workers here are exhausted, they need psychosocial support” says Yemane.

Before the conflict, the hospital was undertaking an expansion plan to upgrade its facilities to provide general hospital-level care which would have made more specialized care available for residents who would otherwise have been required to travel to Shire Endasilassie to receive care. “ I don’t know when we will be able to meet that promise now.”

Communities like Adi Daero where Wahdi comes from continue to need the support of UNFPA to help revitalize infrastructure devastated by conflict. UNFPA Humanitarian Response Appeal 2023 is calling for nearly USD 48 million to respond to the protection and health needs of women and girls across crisis-affected regions in Ethiopia. To date, 38% of the appeal remains unfunded.

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